Sarcoma

Sarcoma is a malignant tumour originating from supportive tissue. Annually, 1,000 suspected sarcoma cases are examined at Tays and approximately 150 patients are diagnosed with a malignant disease. There are many types of sarcoma and their treatment details are always decided individually. The development of the sarcoma treatment methods has been fast and the treatment results are improving continuously.

The majority of sarcoma cases manifest themselves in the area of the musculoskeletal system, so their treatment is the responsibility of musculoskeletal surgeons, i.e. orthopaedists. When necessary, we also invite doctors of other specialities to the sarcoma team.

Examinations at Tays

When an abnormal soft tissue tumour or bone manifestation has been discovered in a patient’s body, for example at a health centre, the patient is referred to Tays for further examinations and treatment.

We invite the patient to the musculoskeletal surgery outpatient clinic within 1–3 weeks from the arrival of the referral and begin the examinations. Usually, the examinations begin with imaging that may involve X-rays, ultrasound examinations, CT scans, magnetic resonance imaging or radionuclide imaging.

Often, a needle biopsy is taken from the soft tissue tumour or bone manifestation to confirm the diagnosis with the help of a microscope. The biopsy is examined to establish whether the tumour is benign or malignant.

The sampling place may be confirmed with an ultrasound examination, if necessary. The skin area is fully anaesthetised before taking the biopsy. If necessary, we reserve a place for the patient at the ward and monitor him/her for a few hours after taking the biopsy.

Treatment negotiation at the Outpatient clinic

When we have received the results of the examinations, a sarcoma nurse contacts the patient to inform him/her of the further treatment plans. We invite the patient to the outpatient clinic for a treatment negotiation in order to discuss upcoming treatments of the disease.

In the treatment negotiation, the patient meets the attending sarcoma doctor, sarcoma nurse and, if necessary, anaesthetist. During the treatment negotiation, we plan ahead. No treatment procedures are done at that time.

Usually, sarcoma is treated with the help of surgery and chemotherapy and radiation therapy and their combinations.

Chemotherapy

The objective of chemotherapy is to destroy cancer cells by damaging their division system in different ways. Cytostatics may be administered orally with the help of tablets or as a solution that is usually administered to a vein, i.e. a blood vessel, with a slow drip.

Normally, we implement the drip at the outpatient clinic of the hospital and the patient is able to return to home afterwards. If the cytostatics are administered as tablets, the medication can be taken at home according to the instructions of the hospital.

Usually, pre-operative chemotherapy lasts approximately three months and is administered at the cancer ward.

Post-operative chemotherapy is called adjuvant pharmacotherapy. Its objective is to ‘kill’ any possible remaining cancer cells in the circulation and thereby prevent the formation of metastases.

Radiation therapy

Radiation therapy makes use of high-energy ionizing radiation. The powerful radiation energy destroys cancer cells by preventing their division and growth. Curative radiation therapy is usually provided in a treatment period lasting 4–8 weeks.

Sometimes, we combine radiation therapy with surgical treatment. Before the surgery, radiation therapy aims to decrease the size of the tumour. The objective of post-operative radiation therapy is to destroy any cancerous foci remaining in the area of the surgery or lymph nodes near the tumour.

Surgical treatment of sarcoma

Usually the patient does not arrive at the surgical ward until the morning of the surgery. If the patient has to travel a great distance, he/she may stay the previous night at the Patient Hotel. However, if pre-operative treatment procedures are performed, the patient is admitted to the ward before the surgery.

We remove the cancerous tumour in the surgery. The scope and duration of the surgery vary greatly according to cancer size, location and possible spread. After the surgery, the patient is given pain relief and we begin rehabilitation as soon as it is safe after the procedure. Recovery at the ward usually takes from a few days to a week.

If sarcoma is situated so close to a joint that its surgery requires the placement of an endoprosthesis, the surgery and related ward treatment is implemented at Coxa Hospital for Joint Replacement. Follow-up controls and other treatment is implemented at Tays Central Hospital.

Follow-up monitoring

The follow-up monitoring usually lasts 5–10 years. At first, the control visits are scheduled every 3–6 months and later on every 1–2 years. At the control visits, imaging is performed to check that the tumour has not recurred or sent metastases.

Further controls take place at the musculoskeletal surgery or cancer outpatient clinic of Tays or at the patient’s own central hospital. Further monitoring depends on the disease diagnosis, tumour size and location.

Sometimes cancer becomes chronic. In such cases, cancer tissue remains in the body but does not spread. During the control visits, we monitor such cancer tissue. In some cases, we are not be able to cure the disease and then we shift the focus from curative treatments to symptom-relieving treatment that improves the quality of life.

Persons in charge

Specialist Juha Kiiski
Specialist Veli-Matti Vainio
Sarcoma Nurses Virpi Aro  Nina Kuni